Sustainability of medical imaging
http://www.100md.com
《英国医生杂志》
EDITOR—Picano asks the impossible in suggesting signed informed consent for radiological examinations.1 To obtain consent for every x ray examination, you need prepared information sheets and forms and some staff experience. Then consider the factor of time.
Allow half a minute each for introducing the documents to the patient, retrieving and checking the forms, fielding average questions, and filing the paperwork. That's two minutes for uncomplicated, intelligent, unquestioning patients who have remembered their reading glasses. Now multiply this time by two or three to allow for incomprehension, obtuseness, terror, etc.
Who will obtain consent? A receptionist? No, because questions on radiation demand scientific understanding. A radiographer, perhaps? How many radiographers have we to spare (let us not even consider radiologists)?
How many people are needed to take consent? A medium sized district general hospital undertakes 100 000 x ray examinations annually, so at least 200 000 minutes (3300 hours) yearly: that's two whole time equivalent trained radiographers.
Where will consent be obtained? Reception areas are too public. In examination rooms, while equipment lies idle? Or in purpose built rooms in our palatial departments?
Now translate this to mobile breast screening units, where each of about 40 daily examinations is allowed effectively 9 minutes. Uncomplicated consent will snatch about 20% of the time.
Yes, radiation must be limited, but we have no time or staff even to vet requests or check reports now. There are highly intelligent believers in informed consent, but why is our trained, knowledgeable, committed "paternalistic attitude" so despised? Along with "appraisal" and "revalidation," it has become the command of the idealist politician that our skills are so misdirected.
Mark Lewars, consultant radiologist
Southend Hospital NHS Trust, Westcliff on Sea SS0 0RY Mark.Lewars@southend.nhs.uk
Competing interests: ML is a consultant radiologist with an active role in breast screening.
References
Picano E. Sustainability of medical imaging. BMJ 2004;328: 578-80. (6 March.)
Allow half a minute each for introducing the documents to the patient, retrieving and checking the forms, fielding average questions, and filing the paperwork. That's two minutes for uncomplicated, intelligent, unquestioning patients who have remembered their reading glasses. Now multiply this time by two or three to allow for incomprehension, obtuseness, terror, etc.
Who will obtain consent? A receptionist? No, because questions on radiation demand scientific understanding. A radiographer, perhaps? How many radiographers have we to spare (let us not even consider radiologists)?
How many people are needed to take consent? A medium sized district general hospital undertakes 100 000 x ray examinations annually, so at least 200 000 minutes (3300 hours) yearly: that's two whole time equivalent trained radiographers.
Where will consent be obtained? Reception areas are too public. In examination rooms, while equipment lies idle? Or in purpose built rooms in our palatial departments?
Now translate this to mobile breast screening units, where each of about 40 daily examinations is allowed effectively 9 minutes. Uncomplicated consent will snatch about 20% of the time.
Yes, radiation must be limited, but we have no time or staff even to vet requests or check reports now. There are highly intelligent believers in informed consent, but why is our trained, knowledgeable, committed "paternalistic attitude" so despised? Along with "appraisal" and "revalidation," it has become the command of the idealist politician that our skills are so misdirected.
Mark Lewars, consultant radiologist
Southend Hospital NHS Trust, Westcliff on Sea SS0 0RY Mark.Lewars@southend.nhs.uk
Competing interests: ML is a consultant radiologist with an active role in breast screening.
References
Picano E. Sustainability of medical imaging. BMJ 2004;328: 578-80. (6 March.)